Barriers and enablers of weight management after breast cancer: a thematic analysis of free text survey responses using the COM-B model

Determinants of lifestyle and body weight status among breast cancer survivors with overweight/obesity and perspectives towards the development of weight loss interventions: a qualitative study with health professionals from Greece

The current study assessed the views and attitudes of health professionals (HPs) regarding factors associated with energy balance-related health behaviours and weight management in breast cancer survivors (BCS) with overweight and obesity. Semi-structured online interviews were conducted with 21 HPs (oncologists, dietitians- nutritionists, physical education instructors, mental health professionals, and nurses) from Attica and Thessaly. Thematic analysis was used to analyse and present the data. Four main themes arose from the data: "The patients' mental health wellbeing", "Survivors' interest in diet and exercise", "Interdisciplinary collaboration in patient's care", and "Maintaining normality". HPs agreed that weight loss in BCS with overweight and obesity is important, but negative mental health wellbeing is a main barrier to behaviour change. For many BCS their cancer diagnosis is a "teachable" moment for weight management, especially for women of younger age, who are more keen to discuss weight management issues. Essential characteristics that determine/facilitate behavioural change include education, commitment for regular communication, personalised intervention, and interdisciplinary collaboration. According to HPs, future weight loss interventions should take into account BCS's mental health wellbeing and level of motivation and should provide regular support and education.

Adoption of a COVID-19 Contact Tracing App by Czech Youth: Cross-Cultural Replication Study

BACKGROUND

During the worldwide COVID-19 pandemic crisis, the role of digital contact tracing (DCT) intensified. However, the uptake of this technology expectedly differed among age cohorts and national cultures. Various conceptual tools were introduced to strengthen DCT research from a theoretical perspective. However, little has been done to compare theory-supported findings across different cultural contexts and age cohorts.

OBJECTIVE

Building on the original study conducted in Belgium in April 2020 and theoretically underpinned by the Health Belief Model (HBM), this study attempted to confirm the predictors of DCT adoption in a cultural environment different from the original setting, that is, the Czech Republic. In addition, by using brief qualitative evidence, it aimed to shed light on the possible limitations of the HBM in the examined context and to propose certain extensions of the HBM.

METHODS

A Czech version of the original instrument was administered to a convenience sample of young (aged 18-29 y) Czech adults in November 2020. After filtering, 519 valid responses were obtained and included in the quantitative data analysis, which used structural equation modeling and followed the proposed structure of the relationships among the HBM constructs. Furthermore, a qualitative thematic analysis of the free-text answers was conducted to provide additional insights about the model's validity in the given context.

RESULTS

The proposed measurement model exhibited less optimal fit (root mean square error of approximation=0.065, 90% CI 0.060-0.070) than in the original study (root mean square error of approximation=0.036, 90% CI 0.033-0.039). Nevertheless, perceived benefits and perceived barriers were confirmed as the main, statistically significant predictors of DCT uptake, consistent with the original study (β=.60, P<.001 and β=-.39; P<.001, respectively). Differently from the original study, self-efficacy was not a significant predictor in the strict statistical sense (β=.12; P=.003). In addition, qualitative analysis demonstrated that in the given cohort, perceived barriers was the most frequent theme (166/354, 46.9% of total codes). Under this category, psychological fears and concerns was a subtheme, notably diverging from the original operationalization of the perceived barriers construct. In a similar sense, a role for social influence in DCT uptake processes was suggested by some respondents (12/354, 1.7% of total codes). In summary, the quantitative and qualitative results indicated that the proposed quantitative model seemed to be of limited value in the examined context.

CONCLUSIONS

Future studies should focus on reconceptualizing the 2 underperforming constructs (ie, perceived severity and cues to action) by considering the qualitative findings. This study also provided actionable insights for policy makers and app developers to mitigate DCT adoption issues in the event of a future pandemic caused by unknown viral agents.

Barriers and facilitators of healthy lifestyle and perspectives towards the development of weight loss programmes. Focus groups with post-treatment breast cancer survivors in Greece

The present study aimed to identify the factors that prohibit or enable breast cancer survivors from adopting a healthy lifestyle, as well as to record patients' suggestions towards developing a weight-loss lifestyle intervention. Twenty-three breast cancer survivors participated in four online, semi-structured focus groups in Greece. All discussions were video-recorded and transcribed verbatim. Participants were 50⋅5 ± 7⋅4 years old with a current mean BMI of 29⋅1 ± 3⋅4 kg/m2. Four main themes emerged from thematic analysis: (1) dietary and lifestyle practices, (2) the effects of cancer on body weight, (3) the impact of cancer on psychology, and (4) the effect of the environment on body weight. Lack of information from healthcare professionals and lack of time were the main barriers to body weight management, whereas the main facilitators were support from their social environment, along with a comfortable physical environment, and the facility of technology. Participants suggested that an effective weight-loss lifestyle intervention should include psychological and social support, guidance and education, collaboration, flexible recommendations, personalised goals, and a follow-up plan. The needs of breast cancer survivors need to be considered when designing weight-loss lifestyle interventions. A personalised approach may prove more effective in promoting a healthy lifestyle and improving patients' care.

Identifying opportunity, capability and motivation of Sri Lankan 5th grade schoolteachers to implement in-classroom physical activity breaks: A qualitative study

BACKGROUND

Classroom-based physical activity interventions have demonstrated positive effects in reducing sedentary behaviour among school children. However, this is an understudied area, especially in low- and middle-income countries such as Sri Lanka. This study aims to explore teachers' opportunity, capability and motivation relating to the implementation of an in-classroom physical activity breaks programme.

METHODS

Twenty-seven teachers were recruited through snowball sampling and participated in semi-structured telephone interviews from early-January to the mid-June 2022. The Capability, Opportunity, and Motivation Behaviour (COM-B) model was used to guide and deductively thematic analyse the interviews.

RESULTS

21 out of the recruited teachers responded to the full study. The mean age of respondents was 39.24 years old ranging from 27 years to 53 years. Teaching experience of the respondents ranged from three to 37 years, and 57% were female. Three teachers had a degree with a teacher training diploma, while others were having General Certificate of Education in Advanced Level with a teacher training diploma as the highest education qualification. Capability factors such as age, dress code, mask wearing, knowledge, skills and workload of the teachers were identified as important factors in implementing a physical activity breaks intervention in a Sri Lankan classroom setting. Classroom space, facilities, student backgrounds and safety were identified as opportunity factors. Obtaining policy level decisions to implement the activity breaks and managing the time of the activities to reduce time lost in education time were identified as motivational factors.

CONCLUSION

During the intervention development phase, implementation facilitators and barriers must be considered carefully. Behaviour change techniques can be utilised to address the identified COM-B factors to ensure a good implementation of the intervention.

Barriers and facilitators of adherence to awake prone positioning: a qualitative study using the COM-B model

BACKGROUND

Awake prone positioning (APP) is a recommended therapy for non-intubated ARDS patients, but adherence can be challenging. Understanding the barriers and facilitators of adherence to APP is essential to increase the adherence of therapy and improve patient outcomes. The objective of this study was to explore the barriers and facilitators of adherence to awake prone ventilation using a qualitative approach and the Capability, Opportunity, Motivation-Behavior (COM-B) model.

METHODS

Semi-structured, in-depth interviews were conducted with patients involved in awake prone ventilation. Data were analyzed using an adapted inductive thematical approach and mapped onto the COM-B model to identify barriers and facilitators to adherence of APP.

RESULTS

Nineteen patients were interviewed (aged 55-92 years). Fifteen themes were identified and mapped directly on to the six COM-B constructs, with "physical challenges" related to physical capability being the primary barrier. These COM-B sub-items reflected five other barriers, including low self-efficacy(M), treatment environment(O), availability of time(O), misconceptions about the treatment(C), and insufficient knowledge(C). Key facilitators in adhering to APP were ability to identify and overcome obstacles(C), availability and affordability of treatment(O), family influences(O), beliefs and trust in treatment(M), fear about the disease(M), and perceived benefits(M). In addition, three factors played the role of both facilitator and barrier, such as media influences(O), healthcare influences(O), and behavioral habits(M).

CONCLUSION

The COM-B model was proved to be a useful framework for identifying the barriers and facilitators of adherence to awake prone ventilation. The findings suggest that adherence behavior is a dynamic and balanced process and interventions aimed at improving adherence to APP should address the barriers related to capability, opportunity, and motivation. Healthcare providers should focus on providing proper guidance and training, creating a comfortable environment, and offering social support to improve patients' capability and opportunity. Additionally, promoting patients' positive beliefs and attitudes towards the treatment and addressing misconceptions and fears can further enhance patients' motivation to adhere to the treatment plan.

Mindfulness-based Interventions and Yoga for Managing Obesity/Overweight After Breast Cancer: A Scoping Review

Introduction

Weight gain after breast cancer is common, and obesity after breast cancer increases breast cancer recurrence and mortality. Mindfulness-based interventions (MBIs) and yoga have been shown to be effective in managing obesity/overweight in people without breast cancer. There is a need to systematically map the extent and range of evidence on yoga and MBIs for managing obesity/overweight after breast cancer in order to aid planning and commissioning of future research.

Methods

We conducted a scoping review informed by methods described by Levac et al. Five electronic databases were searched for any peer-reviewed original research (including systematic reviews) that examined the role of yoga and/or MBIs for managing overweight/obesity after breast cancer. Data were extracted on study, population, intervention, comparator and outcome characteristics, and described narratively.

Results:

We found 18 publications representing 15 unique studies (11 clinical trials, 2 systematic reviews, and 2 observational studies). There were 10 studies on yoga, and 5 on MBIs. Of the clinical trials, only 4/11 examined a weight-related outcome as the primary outcome. The remaining trials examined lifestyle or metabolic outcomes (5/11) or unrelated outcomes such as psychological health (2/11). Gaps in the literature included small sample sizes, lack of cultural diversity amongst participants, inadequate reporting of the intervention, few lifestyle co-interventions offered, lack of active comparator groups, and inadequate safety reporting.

Conclusions:

There is a need for adequately-powered RCTs that adhere to reporting guidelines. The use of gold-standard methods for measuring outcomes, and active comparator groups, is also recommended.